Thursday, September 15, 2011

Government Bureaucracy Gone Wild: Medical Service Codes Go From 18,000 to 140,000

Wall Street Journal -- "Today, hospitals and doctors use a system of about 18,000 codes to describe medical services in bills they send to insurers. Apparently, that doesn't allow for quite enough nuance. A new federally mandated version will expand the number to around 140,000—adding codes that describe precisely what bone was broken, or which artery is receiving a stent. It will also have a code for recording that a patient's injury occurred in a chicken coop. (See code.)"

13 Comments:

I believe that the article title is a little well maybe a whole lot misleading. I read the article and some of the comments by other readers of the article and I found someone whose thoughts I can concur with. Linda, it appeared that she's a doctor who made two good points:#1 There was opportunity for people to review the proposed changes and make comments prior to the passing / implementation of the ICD 10. But I'm sure what happened like with most Americans they have knee jerk reactions and don’t want to get involved with Big Bad Government. They hear something get outraged, talk about it for a moment but don't take the time to invest in the appropriate channels of expressing their viewpoints which can be a catalyst for change in a more positive framework. Therefore what happens is what's happening now people play victim and don't understand what truly happened because they made a conscious choice not to get involved. What happens in this scenario, people complain, blame and eventually accept and go along with the change.#2 I think she brought it home for every American when she said that supermarkets have over 50,000 items in stock but we don't clamor reduce the number of choices, we actually ask for more so that in the midst of the multitudes we can have our individuality (i.e., instead of regular peanut butter, we can have white chocolate wonderful peanut butter blended with sweet white chocolate which helps to quantify our experience with a P&J sandwich in this example). She felt like having more choices allows her to accurately and concisely diagnosis and code the experiences of the people that she serves which helps to be more efficient and may even serve to help reduce overspending in the health care system. When we look to buy a car, clothing, etc. We don't look for the thing that only has two choices but we look for the variety of colors and styles so that we can fully express ourselves. Then why would we ant less choices when describing something as awesome as the human body especially at a time when specificity can help the doctor get to the root cause of the problem in order to get to the right solution.What are your thoughts?

The supermarket example is a good one, as it shows markets responding to customer desire for choice. Nothing that doesn't move off the shelves will continue to be offered for long.

And, while it may be helpful for statistical purposes to have an enormous number of medical codes for insurance billing, which is the primary reason such codes exist at all, as far as I know, it's hard to imagine 140,000 different amounts being billed for medical procedures.

I'm neither a medical nor insurance expert, and a number of different codes might be helpful in describing an injury, but I really don't understand the need for 12 different codes to describe the cause of the injury as an attack by an alligator.

"How do you mjaje things better if you cannnot quantify or identify them? Think of botany or biology. About time we made medical treatment a science."

While there are a large number of distinctions in biology and botany, and there are good reasons to make these distinctions for classification purposes, it's not clear why there should be many codes used to describe a cut finger, or a head cold.

And even if some amount of coded detail is desirable, It's hard to imagine why the cause of an injury, for instance an alligator attack, requires 12 different codes to characterize it.

I suspect that in many cases, the availability of a large numbers of codes will result in random choices by those using the codes, if selection is seen as unnecessarily burdensome.

In other words, there is a level of detail beyond which no one except bean counters have any interest.

Quote from Ezmoney: "... but we don't clamor reduce the number of choices, ..."

These codes have nothing to do with choice or health care. They are only meant to pigeon hole health care into an easily queried database for more complete regulation by a bureaucracy. You might as well be clamoring for more choice in crime (actually, you are).

This does nothing but greaty magnify the number of coding errors. This will not only cause a loss of reimbursements (they don't have to pay you if you've used the wrong code), but it will get people killed. The more detail that appears in a patient's history, the less likely it will be that doctors and nurses will verify that detail, with predictably tragic results.

This can't be good for the litigation side of things, either. The more detail you have, the more you suffer from false positives and spurious correlations.

If a person who equates government codes with choice in the supermarket, is a doctor, I think we have bigger things to worry about in hospitals than these codes.

Ezmoney, what happens when I am incapable of determining if I have been bitten by a mouse, or a rat...subsequently? If I report that it was a mouse, but later turns out to be a rat, have I filed a fraudulent claim?

AIG: "If a person who equates government codes with choice in the supermarket, is a doctor, I think we have bigger things to worry about in hospitals than these codes."

Good point! Thanks.

AIG: "Ezmoney, what happens when I am incapable of determining if I have been bitten by a mouse, or a rat...subsequently? If I report that it was a mouse, but later turns out to be a rat, have I filed a fraudulent claim?"

I believe you have. And, if you were bitten by both, or by either or both more than once, you may need to file as many as 4 reports, unless there is a subsequent complication from any of the bites, in which case there will also be additional codes to report.